The road to Health Integration?

Political commentators always stress the point that the NHS is a major battleground between the main parties and continues to be one of the big ticket vote winners at election time. With May 2015 looming, the think tank Reform held a conference on the future of health on Tuesday, with an opportunity to see the two major health politicians in action. For those non-versed in the current debates around the future of the NHS, they would have been surprised by how much consensus there actually was.

Andy’s 10 year vision

The Shadow Health Secretary, Andy Burnham kicked off the event with an impressive speech outlining his journey to “whole person care” in the next ten years. He stressed the need for full integration to meet the physical, mental and social needs of the population. Despite his criticism of the Coalition’s reforms, he stressed that the NHS needed service reform and not fundamental structural reform. A successful Labour vision, in Burnham’s eyes included the following; the home, not the hospital would become the default setting of care. The focus would be a personalisation of care, with at least one point of contact to deal with individual concerns. Patients would have much more control of their care plans and the focus on traditional medical solutions would change. Exercise advice, counselling and therapy would all form part of the mix on top of traditional treatments in the changing doctor/patient relationship.

Some potential policy ideas were thrown into the mix. This included the proposed “Year of Care” tariff with the idea of consolidating budgets of CCGs, NHS England and social care together to enable better integration. Social care would have to be tackled collectively with NHS care and not remain in silos any longer. Burnham criticised the Coalition policy of reducing social care budgets as it simply created further pressure on NHS services. Patient empowerment was equally important and new rights would be enshrined in the NHS constitution -including the right to a single point of contact and the right to personalised care.

Funding was the last point in his speech and he stressed the need for the NHS to find new revenue streams. He believed raiding other departments would only bring further pressures on the NHS down the line. The proposed mansion tax, tobacco levy and the tax avoidance initiatives were specifically focussed at providing “real new money”. He concluded by saying that Labour founded the NHS and it was now time for Labour to re-set it.

Jeremy’s four pillars

The Health Secretary, Jeremy Hunt then followed later in the day with an equally accomplished performance and with very similar sentiments. Without notes and following on from the earlier spending announcements made this week, he set out the need for further change. He stressed the high quality of most NHS treatment, but accepted that a system had been created that was good at treating individual diseases but not collective problems. There was a need to address “the person”.

Hunt believed the NHS was at a turning point and it would no longer be about simply adding additional money to the problem, but also by changing services. He believed it was the start of a journey to truly tackle the challenge of an ageing population, which was now clearly having an effect on a system that had been built over the past 65 years for a different society.

He welcomed the Five Year Forward plan set out by NHS England and outlined how the Government would back it beyond the next Parliament through 4 key pillars to the plan. The first would be ensuring a strong economy to both secure the necessary government funding required but to also galvanise growth in the dynamic health industry. The Secretary of State believed the Life Sciences industry could be contribute as much as the financial services sector to the economy. The second point was to change models of care to ensure they were joined up. Here he mentioned the idea of multi-year commissioning cycles to help encourage innovation. Hunt also raised the idea of whole person commissioning and CCGs taking responsibility (with others) for public health and social care, as well as primary care. The key, as with his Labour counterpart, was that a focus on out of hospital care was paramount.

The third pillar focussed on ensuring the NHS adapted better to innovation. This required a system that properly invested in new technology and models of adoption to both lower costs, improve outcomes and tackle wastage. The final pillar, which he felt most important, was around changing the culture to ensure effective clinical accountability and transparency. This new culture had to be focussed around the patient to make them the boss and also more responsible in their own care plans.

Consensus, Division and the Future

So the idea of a patient focussed NHS centred away from hospitals, with a greater integration of services that promotes both innovation and a broader range of treatments is a vision that appears to meet a significant amount of cross-party consensus. The question remains then why the NHS becomes such a divisive issue at election time? In part this is due to philosophy of how to get to that vision. There is clearly a divide in terms of funding models and whether the focus needs to be on providing extra revenue streams or making the existing budgets work more efficiently and effectively. Tribal politics also dies hard and the NHS is too easy a target for politicians not to castigate their rivals over, whilst in turn make bold promises around their credibility as able reformers.

The reality is very different and frankly it is a shame that the politicians are not having a more grown up dialogue with the general public as that is what is required. The facts remain that whoever is Secretary of State for Health after May 2015 will be faced with the reality of very little (if any) additional money in the next Parliament to cope with the rising demand for health and social care. The public need to understand this and be part of the conversation in both changing their use of health and social care services, as well as taking ownership of their medical needs. In many ways, healthcare was sheltered from the worst aspects of austerity in this Parliament and it will be a huge challenge to ensure that continues post 2015.

The next Health Secretary will face major challenges financially, but also more significantly in manufacturing the greater integration and patient-centred care so often coveted. Professor Paul Corrigan CBE highlighted in a panel session that everyone agrees with the principles and have done so for many years but we still keep failing to achieve the desired outcome. Both Jeremy Hunt and Andy Burnham gave convincing performances of how to credibly tackle these long term problems. Whether they in reality have the power and commitment to evoke that change and set the NHS tanker on the right course for the next 65 years will be fascinating to see.

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